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Biomedical subjects

M D Murray

Publications and source records attributed to M D Murray.

82 records · Page 5Linked to original sources
PubMedDate not supplied

Pharmaceutical care in chain pharmacies: beliefs and attitudes of pharmacists and patients.

OBJECTIVE: To discuss with pharmacists and patients with reactive airways disease their beliefs about pharmaceutical care and the pharmacist's role in health care, obstacles to providing pharmaceutical care in community pharmacies, and strategies to overcome these obstacles. DESIGN: Two focus groups of patients, two focus groups of pharmacists. PARTICIPANTS: Thirteen patients with reactive airways disease and 11 chain pharmacists. MAIN OUTCOME MEASURES: Qualitative reports on the pharmacist's role in health care delivery and obstacles to implementing pharmaceutical care programs. RESULTS: Pharmacists wished to provide pharmaceutical care, and patients were supportive of pharmacists' involvement in their health care. Both viewed counseling as an important role for pharmacists and believed that pharmacists should work with patients' physicians. Reported obstacles included lack of time, inadequate privacy, and pharmacists' lack of direct access to patients' physicians. Pharmacists and patients believed pharmacists should have access to patient-specific clinical data. CONCLUSION: Focus groups provided valuable information for designing pragmatic pharmaceutical care. The obstacles and possible solutions identified through the discussions represent fertile ground for designing innovative pharmaceutical care programs.

Asthma↗
PubMedDate not supplied

Reliability and validity of the compliance belief scales among patients with heart failure.

BACKGROUND: Lack of medication and dietary compliance leads to troublesome symptoms and hospitalization in patients with heart failure. Compliance behaviors are influenced by beliefs about the behavior. OBJECTIVE: The purpose of this study was to evaluate the reliability and validity of the Beliefs about Medication Compliance Scale (BMCS) and the Beliefs about Dietary Compliance Scale (BDCS) among patients with heart failure. THEORETICAL FRAMEWORK: This study's theoretical framework is the Health Belief Model. METHODS: A convenience sample of 234 patients with heart failure completed the BMCS and the BDCS. Patients completed the scales at baseline by face-to-face interviews and at 8 and 52 weeks after baseline by telephone interview. RESULTS: Construct validity of the scales was supported by confirmatory factor analysis. Both the BMCS and the BDCS had benefits and barriers scales with clear factor loadings. The internal consistency reliability estimates of the scales ranged from.63 to.88, with the BMCS having some estimates lower than.70. The test-retest reliability estimates ranged from.07 to.57. The intraclass correlation coefficient estimates were higher between the 8-week and 52-week scores for all scales. Possible reasons for the varying estimates are discussed. CONCLUSIONS: The BMCS and the BDCS have documented reliability and validity. Future work should be directed at evaluating the responsiveness of the scales to changing patient conditions and testing interventions to improve medication and dietary compliance through changing beliefs.

Adult↗
PubMedDate not supplied

Computerizing guidelines to improve care and patient outcomes: the example of heart failure.

Increasing amounts of medical knowledge, clinical data, and patient expectations have created a fertile environment for developing and using clinical practice guidelines. Electronic medical records have provided an opportunity to invoke guidelines during the everyday practice of clinical medicine to improve health care quality and control costs. In this paper, efforts to incorporate complex guidelines [those for heart failure from the Agency for Health Care Policy and Research (AHCPR)] into a network of physicians' interactive microcomputer workstations are reported. The task proved difficult because the guidelines often lack explicit definitions (e.g., for symptom severity and adverse events) that are necessary to navigate the AHCPR algorithm. They also focus more on errors of omission (not doing the right thing) than on errors of commission (doing the wrong thing) and do not account for comorbid conditions, concurrent drug therapy, or the timing of most interventions and follow-up. As they stand, the heart failure guidelines give good general guidance to individual practitioners, but cannot be used to assess quality or care without extensive "translation" into the local environment. Specific recommendations are made so that future guidelines will prove useful to a wide range of prospective users.

Algorithms↗
PubMedDate not supplied

Effects of computer-based prescribing on pharmacist work patterns.

OBJECTIVE: To measure the effect of computer-based outpatient prescription writing by internal medicine physicians on pharmacist work patterns. DESIGN: Work sampling at a hospital-based outpatient pharmacy. Data were collected from pharmacists wearing silent, random-signal generators before and after the implementation of computer-based prescribing. MEASUREMENTS: The type of work performed by pharmacists (activity), the reason for their work (function), and the people they contacted (contact) were measured. RESULTS: Total staff hours and prescriptions handled were similar before and after computer-based prescribing. Pharmacists recorded 4,687 observations before and 4,735 observations after implementation of computer-based outpatient prescription writing. After implementation, pharmacists spent 12.9 percent more time correcting prescription problems, had 3.9 percent less idle time, and spent 2.2 percent less time in discussions with others. Pharmacists also spent 34.0 percent less time filling prescriptions, 45.8 percent more time in problem-solving activities involving prescriptions, and 3.4 percent less time providing advice. Over 80 percent of pharmacist time was spent working alone both before and after computer-based outpatient prescription writing. CONCLUSION: Computer-based prescribing results in major changes in the type of work done by hospital-based outpatient pharmacists and in the reason for their work and small changes in the people contacted during their work.

Clinical Pharmacy Information Systems↗
PubMedDate not supplied

An aspect of denture base retention: direct measurement of force due to surface tension.

A fixed-volume drop of liquid between a pair of parallel surfaces has been a common model for the denture-mucosa system. The reported one-term equation for the model, the derivation of which is suspect, implies that the acting force is inversely proportional to the square of the separation. Direct measurement of the force, however, showed that a better approximation is given by a two-term equation, with force varying as the inverse of the separation. The need for rigorous theoretical derivation is thereby emphasized. The experimental data suggest that a maximum retention force might occur for denture bases at separations of about 15 microns.

Acrylic Resins↗
PubMedDate not supplied

Orthodontic realignment of a tipped molar abutment using a cast metal removable partial denture.

A combined orthodontic/prosthodontic technique for the treatment of tipped abutment molars is described. The technique uses a cast metal removable partial denture with an uprighting wire and coil spring engaging an orthodontic tube bonded onto the tipped abutment. When the molar has been uprighted to the desired position, a clasp assembly is added to the prosthesis.

Dental Abutments↗
PubMedDate not supplied

Reappraisal of the physics of denture retention.

Theories of denture retention have suffered from confusion of model, algebraic errors, and misapprehension of the physics of capillarity, adhesion and cohesion, as well as the role of atmospheric pressure. The rheology of some simple models is set out in context, and the dynamic nature of the problem is emphasized. The importance of a well-fitting denture base is confirmed. A number of points for further investigation are identified.

Denture Design↗
PubMedDate not supplied

Variable furosemide absorption and poor predictability of response in elderly patients.

STUDY OBJECTIVES: To determine the between- and within-patient variability of furosemide bioavailability and natriuretic response, and whether four marketed products differ in bioavailability and response. DESIGN: Open-label, crossover study. SETTING: General clinical research center at an academic medical center. PATIENTS: Convenience sample of 17 patients age 65 +/- 6 years receiving diuretics for the treatment of hypertension or congestive heart failure. INTERVENTION: Each patient received each of five furosemide products (one intravenous and four oral tablet formulations) twice in random order for a total of 10 treatments. MEASUREMENTS AND MAIN RESULTS: Measurements included absolute bioavailability using cumulative amounts of urinary furosemide collected over 8 hours after oral versus intravenous dosing, and cumulative amounts of urinary sodium. Extensive between- and within-patient variability in all measured values rendered any differences among the products neither clinically nor statistically significant. Mean (+/-SD) bioavailability was 49 +/- 17% (range 12-112%) and coefficients of variation with different products were from 25-43%. Coefficients of variation for urinary furosemide excretion and urinary sodium excretion were also large, 25-42% and 23-51%, respectively. Multivariate analyses that incorporated between- and within-patient effects failed to reveal differences among the products for bioavailability (F = 1.04, p = 0.403), urinary furosemide excretion (F = 1.09, p = 0.371), or urinary sodium excretion (F = 0.97, p = 0.448). Correlation coefficients were 0.81-0.85 for the rates of sodium and furosemide excretion, and half-maximum response using a sigmoid Emax model did not differ among products. CONCLUSION: Although furosemide concentration in urinary and natriuretic responses showed good correlation, variability in bioavailability considerably affects the drug's excretion into urine. Variability in absorption both among patients and within an individual patient is great and overwhelms any differences in bioavailability among approved furosemide products. Switching from one formulation to another will not likely result in any predictable change in patient response.

Administration, Oral↗